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Impact of trans-anal versus laparoscopic total mesorectal excision on the surgical and pathologic outcomes of patients with rectal cancer: meta-analysis of randomized controlled trials

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Abstract

Background

Despite its profound impact on the oncologic outcomes of rectal cancer, the most optimal surgical approach to total mesorectal excision (TME) has not been identified yet. All previous meta-analyses on this subject have been based on observational studies. This meta-analysis was conducted to assess the surgical and oncologic outcomes of laparoscopic TME (LaTME) compared to trans-anal TME (TaTME), utilizing only randomized controlled trials.

Design

Systematic review and meta-analysis of randomized controlled trials.

Methods

We searched electronic databases (MEDLINE, Cochrane CENTRAL, Clinicaltials.gov) from 2010 onwards, for all published clinical trials comparing TaTME to LaTME. Results are presented as risk ratios, with 95% CI, and pooled using the random effects model.

Results

A total of 1691 patients, from 6 eligible randomized controlled trials, were included for analysis. Analyzed data showed no significant difference in morbidity (RR: 0.85, p = 0.15), mortality (RR: 0.50, p = 0.44), conversion to open (RR: 0.40, p = 0.07), or anastomotic leakage (RR: 0.73, p = 0.10) between TaTME and LaTME. There was also no difference in the rate of positive distal resection margin (DRM) (RR: 0.55, p = 0.10) or positive circumferential resection margin (CRM) (RR: 0.67, p = 0.30). Patients undergoing TaTME were more likely to have a complete TME (RR: 1.06, p = 0.002) and shorter hospital stays (RR: − 0.97, p < 0.00001).

Conclusions

Patients undergoing TaTME for rectal cancer were more likely to have a complete TME when compared to LaTME, though this did not translate into improved distal or circumferential resection margin. Additionally, TaTME and LaTME had similar surgical outcomes except for shorter length of stay with TaTME.

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Data availability

The data used for the analysis was extracted from publicly available studies cited in the manuscript. All data analyses supporting the findings of this study are available within the paper and the supplementary information.

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Authors and Affiliations

  1. CMH Medical College Lahore, Lahore, Pakistan

    Mobeen Farooqi, Abdullah Ahmad & Muhammad Daniyal

  2. King Edward Medical University, Lahore, Pakistan

    Ahmed Hussain & Zaofshan Zaheer

  3. Allama Iqbal Medical College, Lahore, Pakistan

    Asma Tahir & Laveeza Fatima

  4. Rashid Latif Medical College, Lahore, Pakistan

    Ruqqaya Maham

  5. United Medical and Dental College, Karachi, Pakistan

    Anoosh Farooqui

  6. Section of Surgical Sciences, Vanderbilt University Medical Center, Nashville, TN, USA

    Aimal Khan

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Contributions

MF: project lead, planning, data analysis, and manuscript writing. AH: data extraction. AA: data analysis and tables. ZZ: data extraction. MD: data analysis and tables. AT; data extraction. LF: literature review and manuscript writing. RM: literature review and manuscript writing. AF: manuscript writing. AK, MD FACS: manuscript, guidance, and consultant advisor. All authors reviewed the manuscript.

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Correspondence to Mobeen Farooqi.

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Farooqi, M., Hussain, A., Ahmad, A. et al. Impact of trans-anal versus laparoscopic total mesorectal excision on the surgical and pathologic outcomes of patients with rectal cancer: meta-analysis of randomized controlled trials. Langenbecks Arch Surg 408, 413 (2023). https://doi.org/10.1007/s00423-023-03147-1

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